This is an example of one Ohio company adjusting how they administer coupons people use at the pharmacy. The program helps make sure members’ out-of-pocket cost for prescription drugs are properly applied to deductibles and maximum out-of-pocket amounts.
The benefit of the coupon is easy to grasp. Someone on an expensive brand medication can obtain it at low or no cost.
The problem can be that the carrier processes it as a paid claim and the member never pays what the plan requires. There are reasons both employers and carriers want real out of pocket to be met by the member.
The carriers now are adjusting and working on ensuring that the member is not given credit or given a reimbursement for something they never paid for personally. Members can use the coupons, but the carrier will credit only what the member actually paid.
This seems like a reasonable solution. It will likely become a normal way coupons are processed.
The ACA imposes a maximum dollar limit on employee contributions to health flexible spending accounts (FSAs). Although the ACA set this limit at $2,500, the limit is indexed for cost-of-living adjustments each year. On Oct. 19, 2017, the IRS announced that, for taxable years beginning in 2018, the dollar limit on employees’ salary reduction contributions to a health FSA will increase to $2,650.
Employers may continue to impose their own dollar limits on employee contributions to health FSAs, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year. For example, an employer may decide to continue limiting employee health FSA contributions for the 2018 plan year to $2,500.
Go here for more information.
Health FSA Limit Will Increase for 2018 10-19-17
Some folks may think that Friday’s Executive Order did away with Obamacare subsidies altogether. It didn’t.
There are two subsidies. One was cut. One wasn’t.
In a nutshell, one subsidy lowers the cost of premium (aka premium tax credits) for those qualified individuals and families enrolled through the exchange and making less than 400% above the poverty level. This stays in place.
The other covers a reduction in the out-of- pocket expenses or claims costs paid to the medical provider by the patient (aka cost-sharing reductions). This subsidy applies to those earning below 250% of the poverty level and covered by a plan issued by the insurance company through the exchange.
It’s this out-of-pocket budget appropriation that was cut by Friday’s Executive Order.
From what we hear, despite Friday’s Order most of those enrollees who qualify for the out-of-pocket assistance will continue to receive it as part of their coverage at least through 2018. Many of the insurance carriers still participating on the exchange expected the subsidy cut and planned for it when they filed their rate increases and established their pricing for 2018.
You can read more here.
Read More >>>
- Tom Barrett
- October 16, 2017
- ACA, affordable care act, cost, costs, employees, enrollment, exchange, federal, health plans, healthcare, healthcare reform, insurance, Obamacare, open enrollment, ruling, subsidies
- 0 Comments
Bob Laszewski is an insurance health industry expert we regularly track to stay up to speed on the national healthcare picture. His typically even-handed analysis has been consistently the most accurate of any of the opinion leaders we follow. Here’s how Laszewski summed up the primary reason for our country’s runaway healthcare costs during a recent interview broadcast on the national news program Full Measure in a segment entitled Zombiecare:
“The healthcare establishment has been getting unlimited dollars from government, from employers, from consumers. They built this incredible infrastructure now that’s very expensive. And the only way we’re going to make healthcare more affordable is to deal with all this infrastructure we’ve got and get it to an efficient place.”
When asked how we address this infrastructure problem, here’s the pragmatic Laszewski take:
“We’re going to have to do it over many years. In the private sector and the public sector, we’re going to have to put them on a diet. It really is the prices we charge. We’re going to have to, in real terms, ratchet those back so that hospitals and doctors understand there’s going to be less money in the years to come.”
During the interview Laszewski addressed several things related to the current status of health insurance and the Affordable Care Act. Among the items he addressed:
The Individual Mandate and Paying the Penalty
“The law technically says that you have to have health insurance. If you don’t have health insurance, you will pay a fine. But the Trump administration has told the Internal Revenue Service, who is in charge of collecting the fines, that when people file their tax returns, if they refuse to say whether they have health insurance or not, the IRS should not pursue them. You technically have to pay it. Your accountant’s probably going to tell you, you technically have to pay it, but it’s not being enforced.”
ObamaCare as Zombie Care(because a Zombie is the walking dead)
“Obamacare is still there, it’s still walking around. It’s still selling health insurance plans to people. But it has no chance in its present form of ever offering affordable and attractive health insurance. And more and more people are just exiting it and going uncovered because they can’t afford it.”
Our takeaway from all this? Be smart. Stay incredibly vigilant. Take full advantage of every tool we have at our disposal to do the best we can to help our clients control costs and navigate the turbulent healthcare waters.
There’s still no clear big picture path anywhere in sight.
To watch the entire interview or to read the full transcript, go here.
Read More >>>
- Tom Barrett
- October 11, 2017
- affordable, affordable care act, confusion, cost, costs, coverage, employers, health plans, healthcare, healthcare reform, hospitals, insurance, medical, Obamacare, penalties, trends
- 0 Comments